Effectiveness of Platelet-Rich Fibrin (PRF) in Post-Extraction Socket Healing Among Diabetic and Non-Diabetic Patients

Abstract

Introduction: Tooth extraction poses an increased risk of delayed healing in diabetic patients due to impaired cellular repair and compromised immune responses. Platelet-Rich Fibrin (PRF), a second-generation platelet concentrate, has emerged as a promising biomaterial for enhancing postoperative healing. This study aimed to evaluate and compare the effectiveness of PRF in promoting post-extraction socket healing in controlled diabetic and non-diabetic patients.

Materials and Methods: This 12-month prospective comparative study was conducted from August 2022 to August 2023 at the Department of Oral and Maxillofacial Surgery, Fatima Jinnah Dental College (DUHS), Karachi. A total of 93 patients undergoing single-tooth extraction were enrolled and divided into two groups: Group A (n = 46, controlled type 2 diabetics, HbA1c < 8%) and Group B (n = 47, non-diabetic individuals). PRF was prepared from autologous blood and placed into extraction sockets following atraumatic extraction under local anesthesia. Standardized postoperative care was provided to all patients. Clinical follow-up was conducted on days 3, 7, and 21, and at 1, 3, 6, 9, and 12 months. Pain was assessed using the Visual Analogue Scale (VAS); soft tissue healing was scored via the Landry, Turnbull, and Howley Index; and bone regeneration was evaluated using a radiographic numeric density scale. Postoperative complications, including infections, were also recorded. Statistical analysis was conducted using SPSS version 26, with p < 0.05 considered statistically significant.

Results: Non-diabetic patients demonstrated significantly lower pain scores (p < 0.001) and superior soft tissue healing by day 21 (p = 0.002). The incidence of postoperative infection was higher in diabetic patients (13.0%) compared to non-diabetics (2.1%) (p = 0.045). Radiographic bone density scores were significantly lower in diabetic patients at 3, 6, and 12 months (p < 0.001). By the 12-month mark, 93.6% of non-diabetic patients achieved complete socket healing compared to 65.2% of diabetic patients (p < 0.001).

Conclusion: The application of PRF significantly enhanced post-extraction healing in both diabetic and non-diabetic patients. However, healing outcomes—including pain reduction, soft tissue regeneration, and bone density—were markedly superior in non-diabetic individuals. These findings underscore the positive role of PRF in clinical socket healing and the need for tailored strategies to improve outcomes in diabetic populations.