EFFECT OF PLATELET-RICH FIBRIN ON POSTOPERATIVE HEALING, EDEMA, AND PAIN IN ORTHODONTIC PREMOLAR EXTRACTIONS: A SPLIT-MOUTH RANDOMIZED CLINICAL TRIAL

Abstract

Objective: To evaluate the effect of platelet-rich fibrin (PRF) on soft tissue healing, facial edema, and postoperative pain following orthodontic premolar extractions using a split-mouth randomized design. Methods: A randomized controlled split-mouth clinical trial (ClinicalTrials. gov: NCT06900036; Ethics Committee: CEISH-UCACUE-031) was conducted in ten healthy patients (mean age: 24.6 ± 5.8 years; range: 17–38) undergoing bilateral premolar extractions, resulting in 36 extraction sockets (19 PRF, 17 control). Outcomes were assessed on days 0, 3, 7, and 14 using the Landry healing index, the Neupert method for facial edema, and the Visual Analog Scale (VAS) for pain. Linear mixed models (LMM) with Bonferroni correction were applied for continuous variables; Friedman and Wilcoxon signed-rank tests for ordinal variables. Significance was set at α = 0.05. Results: No statistically significant differences were found between groups in any evaluated parameter (p > 0.05). Time significantly affected most inflammatory indicators (p < 0.05), reflecting progressive edema resolution in both groups. The time × group interaction was not significant (p > 0.05). Healing reached good-to-excellent levels from day 3 in both groups. The PRF group showed a non-significant trend toward lower early pain scores. Conclusion: In low morbidity surgical contexts, PRF did not significantly improve soft tissue healing, facial edema, or postoperative pain compared with spontaneous healing. Its favorable safety profile supports further evaluation in higher-morbidity settings; however, the present results do not support its routine use in low-complexity orthodontic extractions. Future studies with greater statistical power, higher-morbidity procedures, and three-dimensional evaluation tools are needed to better define its clinical utility.