Objectives: This study aims to analyze the effectiveness of platelet-rich fibrin (PRF) in mandibular third molar extraction and provide suggestions for alleviating postoperative complications.
Methods: Pubmed, EMBASE, Web of Science, and SinoMed were searched electronically on February 2020. Randomized controlled trials focusing on PRF usage in mandibular third molar extraction were included. Reviewers assessed the risk of bias in the included literature and extracted data independently using the criteria recommended by the Cochrane Collaboration. Meta-analysis was performed using RevMan 5.3 and STATA 13.0.
Results: Twenty-one studies were included, comprising 991 patients who had mandibular third molar extraction. The topical application of PRF effectively reduced pain after extraction [MD=-12.06, 95%CI (-21.42, -2.71), P=0.01], attenuated post-extraction swelling [MD=-1.42, 95%CI (-2.41, -0.44), P=0.005], and promoted soft tissue hea-ling [MD=0.66, 95%CI (0.34, 0.99), P<0.000 1]. PRF significantly reduced trismus and alveolar osteitis (P<0.05). However, data could not prove whether PRF has any significant positive effect on bone healing compared with the control group (P>0.05).
Conclusions: Limited clinical evidence indicates that applying PRF after mandibular third molar extraction could reduce pain, swelling, trismus and the occurrence of dry socket and promote soft tissue healing. However, the effect of PRF on bone healing requires further large-scale randomized controlled trials and unified measurement criteria.
目的: 通过系统评价及Meta分析的方法评估下颌第三磨牙拔除术中使用富血小板纤维蛋白（PRF）的有效性，为缓解术后并发症提供建议。方法: 对Pubmed、EMBASE、Web of Science和中国生物医学文献数据库针对在下颌第三磨牙术中使用PRF的临床随机对照试验进行电子检索，检索时间截至2020年2月。评价者使用Cochrane协作网推荐的标准对纳入文献进行偏倚风险评价并提取数据。运用RevMan 5.3和STATA 13.0进行Meta分析。结果: 共纳入21篇研究，包括991位拔除下颌第三磨牙患者。分析结果表明，局部应用PRF可以有效减轻拔牙术后疼痛[MD=-12.06，95%CI（-21.42，-2.71），P=0.01]，降低拔牙后肿胀程度[MD=-1.42，95%CI（-2.41，-0.44），P=0.005]，促进软组织愈合[MD=0.66，95%CI（0.34，0.99），P<0.000 1]，同时能够有效改善术后张口受限、减少干槽症的发生（P<0.05），但在骨愈合方面PRF组与对照组差异无统计学意义（P>0.05）。结论: 目前有限的临床证据显示，下颌第三磨牙拔除术后使用PRF可以改善疼痛、肿胀、张口受限，减少干槽症的发生并促进软组织愈合。但是其对于骨愈合的影响需要进一步进行大规模的随机对照试验并统一测量标准后进行分析。.
Keywords: Meta-analysis; mandibular third molar extraction; platelet-rich fibrin; systematic review.