Effect of platelet-rich fibrin on the control of alveolar osteitis pain, trismus, soft tissue healing, and swelling following mandibular third molar surgery: an updated systematic review and meta-analysis

The purpose of this study was to estimate the effect of platelet-rich fibrin (PRF) on the control of alveolar osteitis (AO), pain, trismus, soft tissue healing, and swelling following mandibular third molar surgery. A comprehensive search of the literature was conducted through PubMed, Embase, Web of Science, and Cochrane Library up to May 2019. Randomized controlled studies conforming to the inclusion criteria were included. The record screening and data extraction were conducted by two authors independently. The risk of bias assessment was performed according to the guidelines recommended by the Cochrane Collaboration. The quantitative analysis was performed using RevMan version 5.3. Nineteen studies were included in the systematic review and 17 studies were eligible for the meta-analysis. The use of PRF significantly reduced the incidence of AO and postoperative pain when compared to the controls (AO: relative risk 0.43, 95% confidence interval (CI) 0.28 to 0.65, Z = 3.90, P < 0.0001 (I-2 = 0%); pain: day 1, standardized mean difference (SMD)-1.12, 95% CI-1.87 to-0.37, Z = 2.93, P = 0.003 (I-2 = 95%); day 3, SMD-0.93, 95% CI -1.48 to -0.38, Z = 3.30, P = 0.001 (I-2 = 92%); day 7, SMD-1.84, 95% CI-2.98 to-0.71, Z = 3.19, P = 0.001 (I-2 = 97%)). Additionally, the result showed a better soft tissue healing when PRF was used (mean difference-0.63, 95% CI-1.08 to-0.18, Z = 2.76, P = 0.006 (I-2 = 90%)). The use of PRF reduced the incidence of AO and postoperative pain following third molar surgery. Furthermore, PRF may also improve the postoperative soft tissue healing.