Prevention of Localized Osteitis in Mandibular Third-Molar Sites Using Platelet-Rich Fibrin

Purpose. To review our experience utilizing platelet rich fibrin (PRF), which is reported to aid in wound healing of extraction sites, for the prevention of localized osteitis following lower third-molar removal. Materials and Methods. PRF was placed in the mandibular third-molar extraction sites, 200 sites total, on 100 consecutive patients treated in our practice, by the authors. The patients were managed with standard surgical techniques, intraoperative IV antibiotic/steroid coverage, and routine postoperative narcotic analgesics/short-term steroid coverage. All patients were reevaluated for localized osteitis within 7–10 days of the surgery. A comparison group consisted of 100 consecutive patients who underwent bilateral removal of indicated mandibular wisdom teeth and did not receive PRF placement within the lower third molar surgical sites. Results. The incidence of localized osteitis (LO) following removal of 200 lower third molars with simultaneous PRF placement within the extraction site was 1% (2 sites out of 200). The group of patients whose mandibular 3rd molar sockets were not treated with PRF demonstrated a 9.5% (19 sites out of 200) incidence of localized osteitis. The latter group also required 6.5 hours of additional clinical time to manage LO than the study group who received PRF. Conclusions. This retrospective review demonstrated that preventative treatment of localized osteitis can be accomplished using a low cost, autogenous, soluble, biologic material, PRF, that PRF enhanced third-molar socket healing/clot retention and greatly decreased the clinical time required for postoperative management of LO. 1. Introduction Localized osteitis (Dry Sockets) may occur in all locations where teeth are removed, but the majority of localized osteitis develops within the mandibular third-molar region (45% of cases) [1]. Localized osteitis is also called alveolar osteitis, alveolitis sicca dolorosa, septic socket, necrotic socket, localized osteomyelitis, and fibrinolytic alveolitis among other terms to describe this phenomenon [2]. When this condition occurs, it is characterized as postoperative pain surrounding the alveolus that increases in severity during a period of 1–3 days after tooth extraction, followed by partial or complete loss of the initial blood clot in the interior of the alveolus (socket) with or without halitosis [1, 3, 4]. This occurs when initial clot formation fails to mature and the normal socket healing sequence fails [5, 6]. When the clot formation does mature, angioblastic ingrowth occurs through the clot and over the