Third molar extraction – does platelet-rich fibrin improve outcomes?


Third molar extraction is very common surgical procedure with post-operative effects including pain, swelling, infection and dry socket. Studies have suggested that platelet-rich plasma (PRP) can reduce these common post-operative problems and improve hard and soft tissue healing. Platelet-rich fibrin (PRF) is a second generation of the platelet concentrate that prevents foreign-body responses.

The aim of this review was to assess the effects of PRF on health and post-operative complication following third molar removal.


Searches were conducted on the Medline, Cochrane Central Register of Trials and Scopus databases. These were supplemented by manual searches of the journals; Journal of Oral and Maxillofacial Surgery, Inter- national Journal of Oral and Maxillofacial Surgery, British Journal of Oral and Maxillofacial Surgery, and Journal of Cranio-Maxillo-Facial Surgery.

English language randomised clinical trials (RCTs) and controlled clinical trials (CCTs) comparing the effect of PRF application on fresh extraction sockets of mandibular third molars versus natural socket healing were considered. Two reviewers independently selected studies and abstracted data. Study quality was assessed using the Cochrane Risk of Bias tool.  Meta-analysis for bone-healing was undertaken and a narrative summary of other outcomes provided.


  • 6 studies (5 RCTs, 1 CCT) involving a total of 183 patients were included.
  • 5 of the 6 studies used a split mouth design.
  • 5 studies were considered to be at low risk of bias.
  • Meta-analysis showed no benefit for bone healing, Mean difference= -0.01%(95%CI; -0.50% – 0.49%).
  • Positive results were generally recorded for pain, trismus, swelling, periodontal pocket depth, soft tissue healing, and incidence of localized osteitis, but not in all studies.


The authors concluded: –

Our review showed contradictory results concerning the effect of PRF on pain, swelling, trismus, and pocket depth after mandibular third molar extractions. This review highlighted the lack of effect of PRF on bone healing. Only 1 study reported the positive role of PRF in soft tissue healing. However, the study was judged to have a high risk of bias.


While the authors have used a good range of sources for their search it has been restricted to English language publications which risks the exclusion of relevant publications. Only 6 studies were included and there involved a small number of patients. While the 5 RCTs were all assessed to be at low risk of bias none of them were at low risk of bias for all 7 elements of the Cochrane risk of bias tool and two of the 6 studies were assessed at high risk of bias some elements. Consequently, this assessment of 5 studies being at low risk of bias appears to be generous.

This review is restricted to post-operative complications and healing following third molar removals and another review by Del Fabbro et al (Dental Elf -26th June 2017) looked more broadly at the impact of these agents on socket healing. While the Del Fabbro review included more studies (including 5 of the 6 studies in this review) and supported their use again the sample sizes were small and a majority of the studies were at high risk of bias.


Primary Paper

Al-Hamed FS, Tawfik MA, Abdelfadil E, Al-Saleh MAQ. Efficacy of Platelet-Rich Fibrin After Mandibular Third Molar Extraction: A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg. 2017 Jun;75(6):1124-1135. doi: 10.1016/j.joms.2017.01.022. Epub 2017 Feb 1. Review. PubMed PMID: 28236425.

Other references

 Dental Elf -26th June 2017

Tooth socket preservation using autologous platelet concentrates




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