Patient reported pain following tooth extraction with different autologous platelet concentrates. Systematic review

Autologous platelet concentrates (APCs) have played a significant role in regenerative dentistry, with clinical evidence suggesting its benefits over controls. Particularly, APCs could reduce postoperative pain following tooth extractions.

To compare patient reported pain after tooth extractions using different autologous platelet concentrates (APCs) such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF).

A search on Pubmed, Scopus, Embase and Google Scholar databases was conducted to identify human studies using APC(s) in extraction sockets between January 2014 and June 2024. This review followed the PRISMA guidelines. The inclusion criteria involved comparative human studies ranging from evidence levels II to III (Oxford Centre for Evidence-Based Medicine Levels of Evidence). For assessing bias in the included studies, the Cochrane Risk of Bias tools were used. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to determine the quality of evidence available.

This review identified 8 studies; with 338 extraction sites in total and 1-15 days pain follow up. Four studies showed no statistically significant difference in postoperative pain reduction between PRP and PRF. One study observed no statistically significant difference between leukocyte-rich PRF (L-PRF) and titanium-prepared PRF (T-PRF). One study indicated that advanced platelet-rich fibrin (A-PRF) is superior to PRF in reducing postoperative pain on day 2 postoperatively. In addition, two studies reported that A-PRF is more effective than L-PRF on day 2. Moderate-to-high risk of bias was identified within 75% of the selected papers. GRADE score for evidence quality assessment was 'Low'.

A-PRF was favoured to reduce postoperative pain on day 2 among the investigated APCs, although the GRADE criteria rate the evidence as "Low". Future trials should directly compare A-PRF with PRF and L-PRF using high-quality randomized controlled designs.