The Effect of Platelet Rich Fibrin On Sensitivity and Periodontal Pockets Distal to Second Molar After Surgical Extraction of Impacted Third Molar

Impacted third molars distal to second molar are the cause of distal attachment loss leading to degradation of the interdental bone. This causes formation of periodontal pocket which leads to pericoronitis and further infection. If there is minimum or no distance between second and third molar, the loss of interdental bone leads to periodonto-pathogenic bacterial aggression. Partially impacted third molars are the active source of bacterial entry into the distal area of the second molar because of food retention and poor oral hygiene.

PRF is the second generation autologous platelet concentrate that is obtained from patient's own blood in simple and cost effective manner. PRF contains platelets, cytokines, leucocytes and circulating stem cells that are embedded in a heterogeneous fibrin matrix. These unique elements in PRF make it a good biomaterial that improves healing. The slow release of cytokines-vascular endothelial growth factor, transforming growth factor, Epidermal growth factor and platelet-derived growth factor-are the main components which play an important role in neo-angiogenesis and tissue repair which makes this particular material useful.

Platelet-Rich Fibrin (PRF), has potential to enhance soft and hard tissue healing However, the evidence surrounding its effectiveness in reduction of sensitivity and periodontal pockets remains inconclusive. Previous studies evaluating the use of PRF have reported contradictory results. While some have demonstrated a significant reduction in periodontal pocket depth and improved healing when PRF is applied to the extraction socket, others have found little to no difference when compared to surgical extraction without PRF placement. This inconsistency highlights the need for further investigation to clarify PRF's role in postoperative outcomes, particularly in relation to periodontal health distal to the second molar. In addition, many of the available studies on PRF in third molar extraction are limited by small sample sizes which reduces the statistical power and generalizability of their findings. Contradiction in their results are most probably due to small sample size Therefore study with larger sample size is required to validate previous results and offer more conclusive evidence Furthermore, there is a notable lack of research focusing on postoperative tooth sensitivity, which is a common patient complaint following third molar extraction. Existing literature has predominantly emphasized parameters such as pain, swelling, and periodontal pocket depth, while the effect of PRF on sensitivity remains largely unexplored. This represents a significant gap in research and patient-centered outcomes.

By assessing periodontal pocket depth, clinical attachment loss and sensitivity distal to the second molar with larger sample size, this study aims to offer a more integrated evaluation of PRF's effectiveness in third molar surgery

Inclusion criteria

• Impacted third molar (as per Operational Definition) with fully erupted second molars bilaterally.
• Impacted Third molar with Class 2 and Level B according to Pell and Gregory's classification (Annexure B) with mesioangular or horizontal angulation of impaction
• Periodontal pocket depth > 4mm and Clinical attachment loss > 1mm at distal side of second molar
• Age 18-40 years, both genders.
• Patients who give informed consent.

Exclusion criteria

• Any Systemic Disease i.e. Uncontrolled Diabetes mellitus, Uncontrolled hypertension, Ischemic heart disease, bleeding disorders, Autoimmune diseases or immunocompromised patients
• Decayed or recommended for extraction second molars on either side.
• Allergic to Amoxicillin to standardize Antibiotic therapy protocol.
• Untreated periodontal condition.
• Inability to follow up.