Effect of Platelet-Rich Fibrin on Postoperative Pain, Trismus, and Edema After Mandibular Third Molar Surgery

Impacted mandibular third molars frequently require surgical removal and represent one of the most commonly performed procedures in oral and maxillofacial surgery. Postoperative complications such as pain, facial swelling, and trismus commonly occur following surgical extraction and may negatively affect oral function and quality of life.

Various approaches have been proposed to reduce postoperative morbidity, including nonsteroidal anti-inflammatory drugs, corticosteroids, cold therapy, hyaluronic acid, and other adjunctive methods. Platelet-rich fibrin (PRF) is a second-generation autologous platelet concentrate that contains a fibrin matrix enriched with platelets, leukocytes, cytokines, and growth factors. These biological mediators contribute to angiogenesis, tissue regeneration, collagen synthesis, and wound healing.

The purpose of this randomized controlled trial is to evaluate the effects of platelet-rich fibrin on postoperative pain, trismus, and facial swelling following surgical removal of mandibular third molars.

Eligible participants aged 18 to 50 years with impacted mandibular third molars fulfilling the inclusion criteria will be recruited from the Department of Oral and Maxillofacial Surgery, Pakistan Atomic Energy Commission General Hospital, Islamabad. After obtaining written informed consent, participants will be randomly assigned to one of two groups:

PRF group: Platelet-rich fibrin will be prepared from the patient's venous blood and placed into the extraction socket before wound closure.

Control group: Sterile absorbable gelatin sponge (Gelfoam) will be placed into the extraction socket before wound closure.

Standardized surgical procedures, local anesthesia, medications, and postoperative instructions will be provided to all participants.

Outcome measures will include:

Postoperative pain assessed using the Visual Analog Scale (VAS). Trismus assessed by maximum interincisal opening measured in millimeters. Facial swelling assessed using standardized facial measurements. Measurements will be recorded preoperatively and on postoperative days 1 and 7.

The primary outcomes are postoperative pain and trismus, while facial swelling is considered a secondary outcome. Statistical analysis will compare outcomes between the two groups to determine whether PRF improves postoperative recovery after mandibular third molar surgery.

Inclusion criteria

Patients aged 18 to 50 years Patients with impacted mandibular third molars indicated for surgical extraction Mesioangular or vertical impactions (Winter classification) Class II or Class III impactions, Position B or C (Pell and Gregory classification) Patients who provide written informed consent

Exclusion criteria

Pregnant or lactating females Patients with systemic diseases affecting healing (e.g., uncontrolled diabetes, immunocompromised states) Smokers Patients on medications affecting bone or soft tissue healing Patients with acute infection at the surgical site