L-PRF for third molar extractions

[TSDentSurg]

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When third molars are extracted, why do most OMFSs leave the socket open, instead of covering it with L-PRF? It wouldn't add that much cost, it'd accelerate healing of the site, and it'd protect the patient from alveolar osteitis and infection, since the socket is no longer communicating with the oral environment.

And why are complex RCTs still done in today's era of implantology? Is there any advantage to having a dead tooth in the periodontium over an implant? Is the only reason endodontics is still around because implants are still expensive? And the occasional bisphosphonate patient where implant surgery would cause a high risk for osteonecrosis.

 

[briansle]

I'm not 100% sure, but I don't think there is a large wide-scale study that proves PRF and PRP has great advantages to mandate it as the standard of care. Lots of orthopedic guys use PRP too, and accelerated healing has alot to do with the "placebo effect" and the power it generates in the mind.

Never underestimate the power of the mind.

I'm sure when more large scale studies definitely show the effectiveness of PRP and PRF on a consistent basis, all the OMFS guys will incorporate it.

As far as RCT's vs Implants. Nothing can come close to God's creation. You try to keep and save what God made for as long as possible.

 

[TSDentSurg]

I'm not 100% sure, but I don't think there is a large wide-scale study that proves PRF and PRP has great advantages to mandate it as the standard of care. Lots of orthopedic guys use PRP too, and accelerated healing has alot to do with the "placebo effect" and the power it generates in the mind.

Never underestimate the power of the mind.

I'm sure when more large scale studies definitely show the effectiveness of PRP and PRF on a consistent basis, all the OMFS guys will incorporate it.

As far as RCT's vs Implants. Nothing can come close to God's creation. You try to keep and save what God made for as long as possible.

Whether it actually accelerates healing or its just the placebo effect, I'd still use it in my practice for extractions and GB/TR procedures as a cheap alternative to collagen barrier membranes. I really don't understand why post-extraction sockets are left open at all. The oral cavity is a cesspool, and leaving a surgical field exposed to that environment just seems to violate basic surgical principles. In my mind, it's like a colorectal surgeon not closing a resection site.

Maybe the OMFSs have empirical knowledge that excellent post-op hygiene and perhaps a short course of prophylactic abx results in post-op surgical site infection rates being very low. I'd still rather take active steps in preventing an infection intra-op, rather than hoping for the best.

So, when a periodontist has a patient who develops post-op osteomyelitis despite their best efforts, would they usually perform the curettage and debridement of the infection site, or would they send the patient to OMFS. IMHO, the periodontist should be the one managing it (unless the infection spreads to the point where a mandibulectomy or maxillectomy is needed, of course, or the patient is ill enough to require admission), as they performed the surgery, and have the skills needed for osseous surgery. And nobody likes dealing with another doctor's surgical complications.

 

[briansle]

I really don't understand why post-extraction sockets are left open at all. The oral cavity is a cesspool, and leaving a surgical field exposed to that environment just seems to violate basic surgical principles. In my mind, it's like a colorectal surgeon not closing a resection site..

My friend....the oral cavity is the only part of your body where you can leave an open wound and have healing occur normally.

It's def not a cesspool. It's a perfect balance of saliva and bacteria. I don't know much about biofilms, but I'm guessing it has something to do with why open extraction sites heal so well on their own.

Hard to make the colon = oral cavity comparison. Probably inhabited by two very different bacterial colonies, pH levels, etc, which accounts for the difference in healing outcomes.

 

[TSDentSurg]

My friend....the oral cavity is the only part of your body where you can leave an open wound and have healing occur normally.

It's def not a cesspool. It's a perfect balance of saliva and bacteria. I don't know much about biofilms, but I'm guessing it has something to do with why open extraction sites heal so well on their own.

Hard to make the colon = oral cavity comparison. Probably inhabited by two very different bacterial colonies, pH levels, etc, which accounts for the difference in healing outcomes.

That makes sense. I'm only a 3rd year, and we've just started clinicals. Still, I'm not too comfortable leaving wounds open when closing them wouldn't be much extra effort and doesn't add risk. Also, the risk of a dry socket if the site isn't closed...they aren't fun.