The influence of platelet-rich plasma on the healing of extraction sockets: an explorative randomised clinical trial

Purpose: To investigate the effect of platelet-rich plasma (PRP) on the healing of hard and soft tissues of extraction sockets with a pilot study. Material and methods: Patients undergoing tooth extraction under intravenous sedation were asked to participate in the trial. Autologous platelet concentrates were prepared from the patients' blood and autologous thrombin was produced. Outcome measures were: pain level, analgesic consumption, oral function (ability to eat food, swallowing, mouth opening and speech), general activity, swelling, bruising, bleeding, bad taste or halitosis, food stagnation, patient satisfaction, healing complications, soft tissue healing, trabecular pattern of newly formed bone in extraction sockets, trabecular bone volume, trabecular separation, trabecular length, trabecular width, and trabecular number. Patients were followed up to 3 months post-extraction. Results: Twelve patients (15 sockets) were randomly allocated to the PRP group and 11 patients (14 sockets) to the control group. Two patients from the control group did not attend any of the scheduled appointments following tooth extraction, and were considered dropouts. Additionally, one more patient from the control group and four patients from the PRP group did not attend their 3-month radiographic assessment appointments. Statistically significantly more pain was recorded in the control group for the first (P = 0.02), second (P = 0.02) and third (P = 0.04) post-operative days for Visual Analogue Scale scores, whereas no differences were observed for the fourth (P = 0.17), fifth (P = 0.38), sixth (P = 0.75) and seventh (P = 0.75) post-operative days. There was a statistically significantly higher analgesic consumption for the first (P = 0.03) and second (P = 0.02) post-operative days in the control group and no differences thereafter. Differences in patients' responses in the health-related quality of life questionnaire were statistically significant in favour of PRP treatment only for the presence of bad taste or bad smell in the mouth (P = 0.03), and food stagnation in the operation area (P = 0.03). The difference between groups was not statistically significant for patient satisfaction with the treatment (P = 0.31). Regarding complications, two dry sockets and one acutely inflamed alveolus occurred in patients of the control group, which determined a borderline statistically significant difference in favour of the PRP group (P = 0.06). Soft tissue healing was significantly better in patients treated with PRP (P = 0.03). Radiographic evaluation carried out by the two blinded examiners revealed a statistically significant difference (P = 0.01) for sockets with dense homogeneous trabecular pattern, a borderline statistically significant difference in the trabecular pattern for bone volume (P = 0.06) favouring PRP use, and no significant differences for trabecular separation (P = 0.66), trabecular length (P = 0.16), trabecular width (P = 0.16) and trabecular number (P = 0.38). Conclusions: PRP may have some benefits in reducing complications such as alveolar osteitis and improving healing of soft tissue of extraction sockets. There were insufficient data to support the use of PRP to promote bone healing or to enhance the quality of life of patients following tooth extraction, although the sample size was too small to detect statistically significant differences. Keywords: extraction socket, healing, platelet-rich plasma, quality of life, radiographs