DENTOALVEOLAR SURGERY

Evaluation of Treatment Outcome After

Impacted Mandibular Third Molar Surgery
With the Use of Autologous Platelet-Rich
Fibrin: A Randomized Controlled
Clinical Study
Nilima Kumar, MDS,* Kavitha Prasad, MDS,y Laitha Ramanujam, MDS,z
Ranganath K, MDS,x Jayashree Dexith, MDS,k and Abhishek Chauhan, MDS{
Purpose: To assess the effect of platelet-rich fibrin (PRF) on postoperative pain, swelling, trismus, peri-
odontal healing on the distal aspect of the second molar, and progress of bone regeneration in mandibular
third molar extraction sockets.
Materials and Methods: Over a 2-year period, 31 patients (mean age, 26.1 yr) who required surgical
extraction of a single impacted third molar and met the inclusion criteria were recruited. After surgical
extraction of the third molar, only primary closure was performed in the control group, whereas PRF
was placed in the socket followed by primary closure in the case group (16 patients). The outcome vari-
ables were pain, swelling, maximum mouth opening, periodontal pocket depth, and bone formation, with
a follow-up period of 3 months. Quantitative data are presented as mean. Statistical significance was
inferred at a P value less than .05.
Results: Pain (P = .017), swelling (P = .022), and interincisal distance (P = .040) were less in the case
group compared with the control group on the first postoperative day. Periodontal pocket depth
decreased at 3 months postoperatively in the case (P < .001) and control (P = .014) groups, and this
decrease was statistically significant. Bone density scores at 3 months postoperatively were higher in
the case group than in the control group, but this difference was not statistically important.
Conclusions: The application of PRF lessens the severity of immediate postoperative sequelae,
decreases preoperative pocket depth, and hastens bone formation.
Ó 2015 American Association of Oral and Maxillofacial Surgeons
J Oral Maxillofac Surg 73:1042-1049, 2015

The optimal management of impacted mandibular
third molars continues to challenge clinicians.1
Numerous indications for surgical extraction of third
molars have been outlined, one of which is the preven-
tion or repair of periodontal defects in adjacent
second molars. A partially impacted third molar
exposed to the oral environment is more susceptible
to periodontal infection and thus to greater peri-
odontal attachment loss.2 There appears to be a sub-
population of patients having third molars removed
that are at ‘‘high risk’’ for periodontal defects after third
molar removal (ie, >26 yr of age; pre-existing peri-
odontal defects [attachment level, >3 mm; probing
depth, >5 mm]; and horizontal or mesioangular

Received from the Department of Oral and Maxillofacial Surgery, Address correspondence and reprint requests to Dr Kumar:
M.S. Ramaiah Dental College and Hospital, Bangalore, Karnataka, Department of Oral and Maxillofacial Surgery, Room no 10, M.S.
India. Ramaiah Dental College and Hospital, Bangalore 560054, Karnataka,
*PG Trainee. India; e-mail: nilima.kumar@rediffmail.com
yProfessor and Department Head. Received March 13 2014
zSenior Professor. Accepted November 15 2014
xProfessor. Ó 2015 American Association of Oral and Maxillofacial Surgeons
kReader. 0278-2391/14/01720-0
{PG Trainee. http://dx.doi.org/10.1016/j.joms.2014.11.013

1042
KUMAR ET AL
impaction). When these 3 risk factors are present
concurrently, there does appear to be a predictable
benefit to reconstructing the dentoalveolar defect at
the time of extraction.3
The immediate postoperative sequelae after third
molar surgery include pain, swelling, and trismus,
and delayed sequelae are seen mostly on the distal
surface of the second molar owing to distal bone
loss, which include prolonged sensitivity due to root
exposure or increased probing depth. Autologous
platelet concentrates, such as platelet-rich plasma
(PRP) and platelet-rich fibrin (PRF), are widely used
for superior wound healing. PRF, a second-generation
platelet concentrate, has been shown to have a more
sustained release of growth factors; it is a simplified
processing technique with minimal biochemical blood
handling compared with PRP.4 Evidence of the effect
of PRF on postoperative sequelae after third molar
surgery is sparse. Therefore, this study was under-
taken to assess the influence of PRF on wound-
healing characteristics of the socket and the defect
distal to the second molar after surgical extraction of
mesioangular or horizontal impactions.
Materials and Methods
This study included patients reporting to an outpa-
tient department for the surgical removal of mesioangu-
lar or horizontally impacted mandibular third molars
from December 2011 to July 2013. The protocol for
the study was approved by the institutional ethics com-
mittee. After preoperative evaluation and obtaining
written informed consent, 31 male and female patients
who could follow postoperative instructions were
selected for the study. Inclusion criteria were healthy
patients 19 to 35 years old, mesioangular or horizontal
mandibular third molar impaction, and a preoperative
platelet count higher than 150,000/mm3. Exclusion
criteria were patients in whom the second molar was
missing or was indicated for extraction, patients with
any underlying systemic disease or compromised
immunity, and pregnant or lactating women.
Patients were randomized by the closed-envelope
method and divided into 2 groups. In the case group
(16 patients), the impacted mandibular third molar
was surgically removed and 5 mL of venous blood
was drawn and centrifuged at 3,000 rpm for 10
minutes to prepare the PRF, which was placed into
the extraction socket followed by flap approximation.
The control group (15 patients) was treated with sur-
gical removal of the impacted mandibular third molar
and flap reapproximation.
Patients were not started on any preoperative anti-
microbials or other drugs that might influence healing,
and a common protocol of investigations and interven-
tions was followed for all patients. Preoperative inves-
1043
tigations included an intraoral periapical radiograph
(IOPAR) of the impacted third molar by the parallel-
cone technique, a panoramic radiograph (OPG), and
platelet count. Oral prophylaxis was performed for
all patients preoperatively. The Silness-Loe gingival
and plaque index was recorded. Pocket depth was
measured using a UNC 15 periodontal probe taken
from the margin of the gingiva to the base of the
pocket along the distal surface of the mandibular
second molar at 3 points (distobuccal, mid-distal, and
distolingual) by a single evaluator.
OPERATIVE PROCEDURE
A standardized operative procedure was carried out
by a single right-handed operator for all patients after
appropriate preoperative evaluation. Under strict
aseptic precautions, 2% lignocaine with 1:200,000
adrenalin was used and an inferior alveolar nerve block
was given. A modified Ward incision was performed
and a full-thickness mucoperiosteal flap was raised.
The tooth was exposed with a round bur, after which
buccal guttering was performed using a straight fissure
bur. Tooth sectioning was performed as deemed neces-
sary after preoperative radiographic evaluation and the
tooth was delivered with elevators. After tooth extrac-
tion, the socket was thoroughly irrigated and freed
from pathologic tissue (eg, granulation tissue), follic-
ular remnants, and bony spicules. In the case group,
after the tooth was delivered, 5 mL of venous blood
was drawn and centrifuged at 3,000 rpm for 10 minutes
and PRF was obtained. The PRF was inserted into the
extraction socket and then closure was performed
using 3-0 Mersilk. In the control group, primary closure
was performed using 3-0 Mersilk sutures. The average
operative time from incision to suturing was 30 to
45 minutes. Postoperatively, all patients were started
on a 3-day course of amoxicillin 500 mg thrice daily,
metronidazole 400 mg thrice daily, a combination of
aceclofenac and paracetamol twice daily, and chlorhex-
idine mouthwash thrice daily. All patients were given
instructions on the importance of maintaining oral
hygiene and jaw physiotherapy postoperatively. Suture
removal was performed on postoperative day 7.
FOLLOW-UP
Patients were evaluated and compared preopera-
tively, postoperatively on the first postoperative day,
at 1 month, and at 3 months. Pain and swelling were
recorded on a visual analog scale according to Pasqua-
lini et al5 on the first postoperative day, at 1 month, and
at 3 months. Interincisal distance was evaluated using
a divider and a scale on the first postoperative day, at
1 month, and at 3 months. Pocket depth was measured
at 1 and 3 months postoperatively and compared with
preoperative values. Radiographic evaluation of the
1044
extraction socket was performed using IOPARs and
OPGs at 1 and 3 months postoperatively (Fig 1A-D).
STATISTICAL ANALYSIS
One-way analyses of variance were used to test the
difference between groups. The Student t test was
used to determine a statistical difference between
groups in the parameters measured. Proportions
were compared by c2 test with Yates correction,
if required.
Results
Age, gender distribution, type of impaction
(Table 1), site of impaction (left or right), preoperative
periodontal pocket depth, and preoperative plaque
score in the case and control groups were comparable
and no statistical difference was noted between the 2
groups. A P value less than .05 was considered statisti-
cally significant.
In this study, pain (P = .017), swelling (P = .022),
and interincisal distance (P = .040) were less in the
case group compared with the control group on the
FIGURE 1. Preoperative and 3-month postoperative intraoral periapical radiographs of A, B, case group and C, D, control group.
Kumar et al. Platelet-Rich Fibrin for Third Molar Surgery. J Oral Maxillofac Surg 2015.
PLATELET-RICH FIBRIN FOR THIRD MOLAR SURGERY
first postoperative day and this difference was statisti-
cally significant (Table 2). Periodontal pocket depth
decreased from the preoperative baseline in the case
(P < .001) and control (P = .014) groups to 3 months
postoperatively and this decrease was statistically sig-
nificant (Table 3). The difference between the 1- and
3-month postoperative values for periodontal probing
depth also was statistically significant in the case
group compared with the control group, suggesting
a greater rate of decrease of pocket depth in the case
group (P < .001; Table 4).
Bone density, recorded as lamina dura, overall den-
sity, and trabecular pattern scores at 1 and 3 months
postoperatively, was greater in the case group
compared with the control group, but this difference
was not statistically important (Table 5).
Discussion
Socket healing is a highly coordinated sequence of
biochemical, physiologic, cellular, and molecular
responses involving numerous cell types, growth fac-
tors, hormones, cytokines, and other proteins, which
KUMAR ET AL 1045

Table 1. DISTRIBUTION OF IMPACTION IN CASE AND

CONTROL GROUPS
Classification
Mesioangular Horizontal Total
Control 10 5 15
Case 9 7 16
Total 19 12 31
Note: A P value less than .05 was considered significant.
Kumar et al. Platelet-Rich Fibrin for Third Molar Surgery. J Oral
Maxillofac Surg 2015.
are directed toward restoring tissue integrity and func-
tional capacity after injury. It is a specialized example
of healing by second intention.6
The presence and removal of impacted third molars
can negatively affect the periodontium of adjacent
second molars as reflected in the disruption of the
periodontal ligament, root resorption, and pocket
depth associated with loss of attachment.3 Periodontal
defects, as assessed by pocket depths, increase with
increasing age in the presence of retained third
molars.3 The present study included young healthy
patients 19 to 35 years old. The mean age of the case
group was 25.25  4.20 years and that of the control
group was 27.00  5.27 years and no statistical differ-
ence was noted between the 2 groups, suggesting that
they were comparable. The literature suggests that the
incidence of postoperative morbidity after third molar
removal is higher in patients older than 25 years.3,7
Other studies on third molar surgery and the use of
PRP in the extraction socket have reported a similar
age range for their patients.6,8-12
The preoperative existence of an intrabony defect,
P Value
age of the patient, and level of plaque control could
serve to predict adverse outcomes.3 In the present
.552 study, periodontal pocket depth was recorded preop-
eratively and 1 and 3 months postoperatively. When
there is a close association between the second and
third molars, it might be difficult to judge the probing
depth appropriately because the cusps of the
impacted tooth could prove a hindrance, and in such
cases, the postoperative probing depth might be
greater than the preoperative value. The preoperative
pocket depth in the 2 groups was recorded (mean, 5.9
 0.87 mm in case group; mean, 6.09  1.28 mm in
control group), and the difference between the 2
groups was not statistically different, indicating that
the 2 groups were comparable. In other studies
conducted on the use of PRP in the extraction socket
of third molars,6,8,10 a preoperative periodontal
pocket of at least 7.5 mm was mandatory, because
they addressed deep mesioangular impactions.
Kan et al13 identified 3 possible risk indicators asso-
ciated with localized increased probing pocket depth,
namely mesioangular impactions, pre-extraction
crestal radiolucency, and inadequate postextraction
plaque control. In agreement with the findings of
Kan et al,13 all 31 patients included in the present
study had a mesioangular or horizontal impaction

Table 2. DISTRIBUTION OF PAIN, SWELLING, AND MEAN INTERINCISAL DISTANCE IN CASE AND CONTROL GROUPS
ON FIRST POSTOPERATIVE DAY

Pain

None Mild Slight Severe Total P Value

Control 6 (40.0%) 6 (40.0%) 3 (20.0%) 15 (100.0%) .017*

Case 14 (87.5%) 2 (12.5%) 0 (0%) 16 (100.0%)
Swelling

None Mild Slight Severe Total P Value

Control 7 (46.7%) 5 (33.3%) 3 (20.0%) 15 (100.0%) .022*

Case 13 (81.3%) 3 (18.8%) 0 (0%) 16 (100.0%)
Mean Interincisal Distance

n Mean SD Min Max P Value

Control 15 31.07 3.195 26 36 .040*

Case 16 33.00 1.592 30 35
Abbreviations: Max, maximum; Min, minimum; SD, standard deviation.
* Statistically significant (P < .05).
Kumar et al. Platelet-Rich Fibrin for Third Molar Surgery. J Oral Maxillofac Surg 2015.
1046 PLATELET-RICH FIBRIN FOR THIRD MOLAR SURGERY

Table 3. COMPARISON OF MEAN POCKET DEPTH IN

eratively. On the first postoperative day, pain and
CASE AND CONTROL GROUPS PREOPERATIVELY AND swelling were considerably less in the case group
1 AND 3 MONTHS POSTOPERATIVELY compared with the control group. In the case group,
87.5% of patients complained of mild pain, 12.5% com-
Group n Mean SD Min Max P Value
plained of slight pain, and none complained of severe
pain, whereas in the control group, 40% complained
Control
Preoperatively 15 6.09 1.28 4 9
of mild pain, 40% complained of slight pain, and 20%
Month 1 15 5.24 1.04 3 7 .014* complained of severe pain. This difference between
postoperatively the 2 groups was statistically significant (P = .017), indi-
Month 3 15 4.78 1.20 3 7 cating that the application of PRF in the extraction
postoperatively socket aided in decreasing patients’ postoperative
Case pain (Table 2).
Preoperatively 16 5.94 0.87 4 7 There was no swelling in all 31 patients preopera-
Month 1 16 4.88 0.64 3 6 <.001* tively and at 1 and 3 months postoperatively. On the first
postoperatively postoperative day, swelling was noted in the 2 groups.
Month 3 16 3.40 0.49 3 4 In the case group, 81.3% complained of mild swelling,
postoperatively
18.8% complained of slight swelling, and none com-
Abbreviations: Max, maximum; Min, minimum; SD, standard plained of severe swelling; in the control group,
deviation. 46.7% complained of mild swelling, 33.3% complained
* Statistically significant (P < .05). of slight swelling, and 20.0% complained of severe
Kumar et al. Platelet-Rich Fibrin for Third Molar Surgery. J Oral swelling. This difference between the 2 groups was sta-
Maxillofac Surg 2015.
tistically significant (P = .022), indicating that the appli-
cation of PRF in the socket decreased the postoperative
with an increased probing depth on the distal aspect swelling experienced by the patients (Table 2).
of the third molar, and their plaque score was recorded Interincisal distance was recorded in all patients
to ensure pre- and postextraction plaque control. The preoperatively, on the first postoperative day, and at 1
plaque score of the patients was recorded preopera- and 3 months postoperatively to assess restriction in
tively to rule out any pre-existing periodontal compro- mouth opening in the 2 groups. All 31 patients
mise owing to poor oral hygiene. The difference recorded no restriction in mouth opening preopera-
between plaque scores at different intervals was not tively or at 1 and 3 months postoperatively. The
statistically meaningful, suggesting that oral hygiene mean preoperative mouth opening in the case group
was maintained throughout the study duration in the was 40.50  1.71 mm and that in the control group
2 groups. Thus, plaque was not a risk factor for the was 39.93  2.57 mm, and the difference between
persistence of pocket depth postoperatively. the 2 groups was not important, indicating they were
Postoperative sequelae, such as pain, swelling, and comparable. On the first postoperative day, mouth
mouth opening, were recorded for all patients preoper- opening was 33.00  1.59 mm in the case group and
atively and postoperatively at first postoperative day, at 31.07  3.19 mm in the control group, and this differ-
1 month, and at 3 months. There was no pain in all 31 ence was statistically significant (P = .040), indicating
patients preoperatively and at 1 and 3 months postop- that the use of PRF influenced the degree of restriction
of mouth opening (Table 2).
Table 4. COMPARISON OF MEAN POCKET DEPTH IN This finding was in contrast to a similar case-and-
CASE AND CONTROL GROUPS PREOPERATIVELY TO control study conducted by Ogundipe et al6 on the
1 MONTH POSTOPERATIVELY AND PREOPERATIVELY use of autologous PRP gel to increase healing after
TO 3 MONTHS POSTOPERATIVELY
surgical extraction of mandibular third molars. In
Mean P that study, the PRP group had decreased pain,
Group Visit Difference Value swelling, and trismus compared with the control
group, but this difference was statistically important
Control preoperative vs month 1 0.844 .135 only for postoperative pain. Therefore, PRF seems to
preoperative vs month 3 1.311 .011* have a more positive influence on postoperative
month 1 vs 3 0.467 .530 sequelae. There is no other study on the use of PRF
Case preoperative vs month 1 1.063 <.001* after surgical extraction of mandibular third molars
preoperative vs month 3 2.542 <.001* and the simultaneous assessment of subjective and
month 1 vs 3 1.479 <.001* objective postoperative sequelae.
* Statistically significant (P < .05). Sammartino et al8 stated that the extraction of
Kumar et al. Platelet-Rich Fibrin for Third Molar Surgery. J Oral mesioangular impacted third molars can cause multiple
Maxillofac Surg 2015. periodontal defects at the distal root of the
KUMAR ET AL
Table 5. DISTRIBUTION OF LAMINA DURA, OVERALL DENSITY, AND TRABECULAR PATTERN IN CASE AND CONTROL
GROUPS AT 3 MONTHS POSTOPERATIVELY
Lamina Dura
Within Normal Limits Absent
Control 0 (0%) 9 (60.0%)
Case 0 (0%) 8 (50.0%)
Overall Density
Within Normal Limits Mild to Moderate Increase
Control 0 (0%) 14 (93.3%)
Case 0 (0%) 11 (68.8%)
Trabecular Pattern
Within Normal Limits Somewhat Coarser
Control 1 (6.7%) 14 (93.3%)
Case 1 (6.3%) 11 (68.8%)
Statistically significant (P < .05).
Kumar et al. Platelet-Rich Fibrin for Third Molar Surgery. J Oral Maxillofac Surg 2015.
second molar. In the present study, the mean preopera-
tive pocket depth in the case group was 5.9 
0.87 mm and that in the control group was 6.09 
1.28 mm, and the difference between the 2 groups was
not statistically important, indicating that the 2 groups
were comparable. The 1-month postoperative pocket
depth in the case group was 4.88  0.64 mm and that
in the control group was 5.24  1.04 mm, and at 3 months
postoperatively it was 3.40  0.49 mm in the case group
and 4.78  1.20 in the control group (Table 3). Postoper-
ative pocket depth recorded at 1 and 3 months was less in
the case group compared with the control group, but this
difference was statistically significant only at the end of
3 months (P < .001), indicating better periodontal heal-
ing in the case group compared with the control group.
These results were comparable to other reported studies
in the literature.6,8,10 Sammartino et al8 reported that PRP
was effective in inducing and accelerating bone regener-
ation for the treatment of periodontal defects at the distal
root of the mandibular second molar after surgical extrac-
tion of a mesioangular, deeply impacted mandibular third
molar and recorded a pocket depth of 4.13  1.34 mm at
12 weeks, whereas in the present study a probing depth
of 3.40  0.49 mm was noted at the end of 3 months
(12 weeks). In 2009, Sammartino et al10 performed
another study on the use of PRP alone and PRP with
resorbable membrane for the prevention of periodontal
defects after deeply impacted lower third molar extrac-
tion and found the PRP with Bio-Gide (Geistlich
Biomaterials, Wolhusen, Switzerland) membrane
showed early signs of bone maturation, but not a higher
grade of bone regeneration.10
1047
Substantially Thinned Total P Value
6 (40.0%) 15 (100.0%) .576
8 (50.0%) 16 (100.0%)
Severe Increase Total P Value
1 (6.7%) 15 (100.0%) .083
5 (31.3%) 16 (100.0%)
Substantially Coarser Total P Value
0 (0%) 15 (100.0%) .115
4 (25.0%) 16 (100.0%)
Further statistical analysis between the follow-up
visits showed that mean pocket depth was 5.94 
0.87 mm preoperatively, 4.88  0.64 mm at 1 month
postoperatively, and 3.40  0.49 mm at 3 months post-
operatively in the case group (P < .001) and 6.09 
1.28 mm preoperatively, 5.24  1.04 mm at 1 month
postoperatively, and 4.78  1.20 mm at 3 months post-
operatively in the control group (P = .014). This
decrease in pocket depth was statistically important
in the 2 groups, suggesting a decrease in pocket depth
postoperatively in the case and control groups after
extraction of the impacted third molar (Fig 2). As pre-
sented in Table 4, the control group showed a decrease
in pocket depth from preoperatively to 1 and 3 months
postoperatively, but this difference was statistically
important only at 3 months. In the case group, the
decrease in pocket depth from the preoperative value
was noted at 1 and 3 months, and this decrease was sta-
tistically important at the 2 intervals, indicating a faster
rate of decrease of pocket depth in the case group.
In the present study, IOPARs, obtained with the
parallel-cone technique, and OPGs were used for the
radiographic evaluation of the distal bone defect in
relation to the lower second molar preoperatively and
for the 1- and 3-month postoperative follow-ups as
described by other investigators.6,8,10,11 The IOPARs
and OPGs in the present study were converted to
digital images and studied by a single radiologist who
was blinded to the study group. The evaluation of
bone density in this study was performed using a
scoring system suggested by Ogundipe et al6 in which
scores were listed for the lamina dura, overall density,
1048
FIGURE 2. Comparison of mean pocket depth in case and control groups preoperatively and 1 and 3 months postoperatively.
Kumar et al. Platelet-Rich Fibrin for Third Molar Surgery. J Oral Maxillofac Surg 2015.
and trabecular pattern appreciable on an IOPAR. The
lamina dura, overall density, and trabecular pattern
scores were higher in the case group compared with
the control group, indicating a greater bone density in
the case group. This difference was not statistically
different between the 2 groups (Table 5). The higher
scores in the case group suggested a faster rate of
bone deposition compared with that in the control
group, which was similar to the results of other studies.6
In contrast to these findings, a scintigraphic evalua-
tion of osteoblastic activity in extraction sockets
treated with PRF was carried out by Gurbuzer et al14
in 14 patients with bilateral soft tissue impacted
mandibular third molars; they reported that PRF ex-
hibits the potential characteristics of an autologous
fibrin matrix, but might not lead to enhanced bone
healing in soft tissue impacted mandibular third molar
sockets 4 weeks after surgery. This difference could be
due to the varied technique of preparation of PRF in
the study conducted by Gurbuzer et al.14 In their
study, they had used a centrifugation rate of
2,030 rpm for 10 minutes, whereas the standard prep-
aration suggested by Dohan et al15 is 3,000 rpm for
10 minutes. In a systematic review conducted by Del
Fabbro et al16 on the use of autologous platelet con-
centrates in postextraction socket healing, favorable
soft and hard tissue healing and a postoperative
decrease in discomfort were reported by various
PLATELET-RICH FIBRIN FOR THIRD MOLAR SURGERY
researchers, but owing to the lack of standardization
of the technique for the preparation of these concen-
trates, their true regenerative effects were unknown.
To summarize, this study evaluated the effectiveness
of PRF in third molar extraction sockets for wound
healing by assessing postoperative pain, swelling,
mouth opening, periodontal healing, and bone regen-
eration clinically and radiographically. Because the
literature suggests PRF is superior to PRP4,17,18 in
inducing soft and hard tissue healing owing to a
sustained release of growth factors, PRF was chosen.
A statistically important decrease in pain, swelling,
and restriction in mouth opening was noted in the
case group. Periodontal pocket depth was seen to
decrease in the 2 groups postoperatively, but the
extent of decrease was statistically different in the
case group compared with the control group.
Radiographic evaluation of the bone formation
showed that scores were higher in the case group,
but this difference was not statistically important.
These results indicated that in the case group the
postoperative sequelae experienced by the patients
were less compared with the control group. There
also was accelerated periodontal healing and bone
formation in the case versus control group.
In the present study, the case group had less pain,
swelling, and trismus on the first postoperative day
compared with the control group. The decrease in pain
KUMAR ET AL
and swelling, although statistically important, should be
considered with caution because these are based on a
subjective visual analog scale score. Also, increased and
faster periodontal healing was observed in the case
group, with a statistically important decrease in probing
depths at the distal root of the mandibular second molar
after surgical extraction of mesioangular and horizontally
impacted mandibular third molars. Bone density scores
also were higher for the case group, although not statisti-
cally different. Therefore, PRF can be considered a viable
option for socket healing after surgical extraction of
impacted mandibular third molars. This study had the
limitation of a small sample and a short follow-up. A study
with a larger sample with a longer follow-up is warranted
to obtain a more statistically meaningful result with
respect to bone regeneration.
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