Evaluation of the usefulness of platelet-rich fibrin (PRF) in mandibular third molar surgery with 3D facial swelling analysis: a split-mouth randomized clinical trial

Background: Third molar surgery is associated with various postoperative complications (PC). Different strategies, including the application of platelet-rich fibrin (PRF), have been implemented to reduce PC. Digital technologies have proven useful in objectively assessing postoperative facial swelling. This study aimed to evaluate the effect of PRF on reducing facial swelling after lower third molar surgery using a 3D face scanner. Methods: A randomized split-mouth clinical trial was set up and 32 patients (18 to 32 years), requiring extraction of both mandibular third molars, were recruited at the Oral Surgery Clinic of the Magna Graecia University of Catanzaro. The primary predictive variable was the application or not of PRF plugs and membranes in the post-extraction socket. Primary outcome variable was facial swelling recorded with a face scanner preoperatively (T0), after three (T1) and seven (T2) days. Qualitative and quantitative data analysis were conducted following an automated and standardized imaging analysis workflow using the 3D Slicer software. Secondary outcome variables were trismus, recorded by measuring the maximum buccal opening with a caliper, pain, recorded using a visual analogue scale (VAS), and duration of the surgery. Descriptive and bivariate analysis were performed by setting the significance level = 0.05. Results: All patients exhibited a significant increase in facial swelling at T1, followed by a subsequent reduction from day 3 to day 7, with a slight persistence of edema observed on the seventh day. No significant data emerged from the statistical analysis conducted. Linear differences in PRF group reported improved values of postoperative swelling only in the T1-T2 and T0-T2 phases of analysis. Volumetric differences favored PRF group compared with control group in all phases. VAS was lower in PRF group only at T2, compared with control group. Conclusions: Application of PRF in post-extraction sockets showed effectiveness in reducing facial swelling. Its advantages, including accessibility, cost-effectiveness, and absence of adverse reactions, make it an optimal treatment choice in reducing post-surgical sequelae.