Comparison of bone repair of advanced platelet-rich fibrin (A-PRF) and leukocyte- and platelet-rich fibrin (L-PRF) following the extraction of impacted third molars: a randomized clinical trial

Abstract

To compare the effects of leukocyte- and platelet-rich fibrin (L-PRF) and advanced platelet-rich fibrin (A-PRF) on bone healing and postoperative outcomes following impacted third molar extraction (ITME). A randomized, double-blind, split-mouth clinical trial was conducted in patients undergoing bilateral ITME. One extraction socket received L-PRF and the contralateral socket received A-PRF. The primary outcome was bone volume at the extraction socket, assessed by cone-beam computed tomography (CBCT), as a measure of bone healing. Secondary outcomes included trabecular thickness, trabecular spacing, soft tissue healing assessed using the modified Landry healing index, postoperative pain assessed using a visual analog scale (VAS), and facial swelling. Statistical significance was set at p < 0.05. Thirty-five patients were included in the final analysis. No significant differences were observed in bone volume between the L-PRF (21.04 ± 7.46) and A-PRF (21.43 ± 7.65) groups (p = 0.802). Trabecular thickness was significantly greater in the A-PRF group (p = 0.012), whereas trabecular spacing did not differ between groups. An exploratory time-specific comparison showed lower pain scores in the L-PRF group at 8 h postoperatively (p = 0.046), although no significant overall treatment effect was observed for postoperative pain. No significant differences were identified regarding facial swelling or soft tissue healing. Within the limitations of this randomized clinical trial, L-PRF and A-PRF demonstrated comparable effects on bone healing and postoperative clinical outcomes following impacted third molar extraction. Trial registration Brazilian registry of clinical trials [ReBEC] number: RBR-10vc6r63.