A Comparative Study of Platelet-Rich Fibrin Alone and Platelet-Rich Fibrin Combined with Hydroxyapatite for Healing of Impacted Mandibular Third Molar Extraction Sockets

Abstract

Background: Surgical removal of impacted mandibular third molars is frequently associated with postoperative pain, swelling, trismus and delayed socket healing. Platelet-rich fibrin (PRF) promotes tissue regeneration through the sustained release of growth factors, while hydroxyapatite (HA) provides an osteoconductive scaffold that supports bone formation. Their combined application may improve postoperative healing.

Aim: To compare the efficacy of PRF alone and PRF combined with hydroxyapatite in promoting soft and hard tissue healing following surgical removal of impacted mandibular third molars.

Materials and Methods: This randomized controlled clinical study included 60 patients requiring surgical removal of impacted mandibular third molars at the Department of Oral and Maxillofacial Surgery. Participants were allocated into two groups: PRF alone and PRF combined with HA. Postoperative pain, facial swelling, trismus and soft tissue healing were evaluated on postoperative days 1, 3 and 7. Bone density was assessed using digital orthopantomograms four months postoperatively. Between-group comparisons were performed using independent-samples t-tests and the Mann–Whitney U test, as appropriate.

Results: The PRF with HA group demonstrated significantly lower postoperative swelling along the mouth-to-tragus and tragus-to-pogonion measurements on days 1, 3 and 7 (p<0.001). No statistically significant differences were observed in swelling measured along the outer canthus-to-mandibular angle, postoperative pain or trismus between the groups (p>0.05). Soft tissue healing scores were comparatively higher in the PRF with HA group on day 7, although the difference was not statistically significant (p=0.077). Four-month radiographic assessment demonstrated significantly greater bone density in the PRF with HA group (p=0.001).

Conclusion: The combination of PRF and hydroxyapatite demonstrated advantages over PRF alone, particularly in reducing postoperative facial swelling and improving radiographic bone density. However, no significant additional benefit was observed for postoperative pain, trismus or soft tissue healing. The combination may therefore be a useful adjunct for improving healing outcomes following impacted mandibular third molar surgery.