Effectiveness of Platelet-Rich Fibrin (PRF) in Post-Extraction Socket Healing Among Diabetic and Non-Diabetic Patients
DOI:
https://doi.org/10.62497/irjd.104Keywords:
Platelet-Rich Fibrin, Diabetes Mellitus, Healthy Volunteers, Tooth Extraction, Wound Healing, Pain Management, Bone Regeneration, Oral Surgical ProceduresAbstract
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.
References
Martínez-García M, Hernández-Lemus E. Periodontal Inflammation and Systemic Diseases: An Overview. Front Physiol. 2021 Oct 27;12:709438. doi: 10.3389/fphys.2021.709438.
Sirin DA, Ozcelik F, Uzun C, Ersahan S, Yesilbas S. Association between C-reactive protein, neutrophil to lymphocyte ratio and the burden of apical periodontitis: a case-control study. ActaOdontologicaScandinavica. 2019 Feb 17;77(2):142-9.
Esteves-Lima RP, Reis CS, Santirocchi-Júnior F, Abreu LG, Costa FO. Association between periodontitis and serum c-reactive protein levels. Journal of clinical and experimental dentistry. 2020 Sep 1;12(9):e838.
MoradiHaghgoo J, Torkzaban P, Farhadian M, MoosaviSedeh SA. Association between the severity of periodontitis, COVID-19, C-reactive protein and interleukin-6 levels in hospitalized patients: a case‒control study. BMC Oral Health. 2023 Aug 11;23(1):556.
Machado V, Botelho J, Escalda C, Hussain SB, Luthra S, Mascarenhas P, Orlandi M, Mendes JJ, D’Aiuto F. Serum C-reactive protein and periodontitis: a systematic review and meta-analysis. Frontiers in immunology. 2021 Jul 28;12:706432.
Wojtkowska A, Zapolski T, Wysokińska-Miszczuk J, Wysokiński AP. The inflammation link between periodontal disease and coronary atherosclerosis in patients with acute coronary syndromes: case–control study. BMC Oral Health. 2021 Dec;21:1-7.
Leira Y, Carballo Á, Orlandi M, Aldrey JM, Pías‐Peleteiro JM, Moreno F, Vázquez‐Vázquez L, Campos F, D’Aiuto F, Castillo J, Sobrino T. Periodontitis and systemic markers of neurodegeneration: A case–control study. Journal of Clinical Periodontology. 2020 May;47(5):561-71.
Sharma H. C-reactive protein levels in patients with periodontal disease: A case control study.
Jain R, Kudva P. Clinico-biochemical evaluation of relationship between periodontitis and Creactive protein: A case control study. Journal of Advanced Medical and Dental Sciences Research. 2021 Mar 1;9(3):11-6.
Rodríguez-Lozano B, González-Febles J, Garnier-Rodríguez JL, Dadlani S, Bustabad-Reyes S, Sanz M, Sánchez-Alonso F, Sánchez-Piedra C, González-Dávila E, Díaz-González F. Association between severity of periodontitis and clinical activity in rheumatoid arthritis patients: a case–control study. Arthritis research & therapy. 2019 Dec;21:1-2.
Mohammed SM, Hasan AS, Al-Hindy HA, Mousa MJ. C-reactive protein is associated with the severity of periodontal disease-an observational study among acute myocardial infarction patients. Sys Rev Pharm. 2020 Oct 1;11(10):252-7.
Tonguç MÖ, Öztürk C, Polat G, Bobuşoğlu O, Tek SA, Taşdelen B, Ünal S. Investigation of the relationship between periodontal and systemic inflammation in children with Sickle Cell Disease: A case-control study. Cytokine. 2022 Jan 1;149:155724.
Said KN, Al-Momani AM, Almaseeh JA, Marouf N, Shatta A, Al-Abdulla J, Alaji S, Daas H, Tharupeedikayil SS, Chinta VR, Hssain AA. Association of periodontal therapy, with inflammatory biomarkers and complications in COVID-19 patients: a case control study. Clinical Oral Investigations. 2022 Nov;26(11):6721-32.
Marouf N, Cai W, Said KN, Daas H, Diab H, Chinta VR, Hssain AA, Nicolau B, Sanz M, Tamimi F. Association between periodontitis and severity of COVID‐19 infection: A case–control study. Journal of clinical periodontology. 2021 Apr;48(4):483-91.
Lyra P, Botelho J, Machado V, Rota S, Walker R, Staunton J, Proença L, Chaudhuri KR, Mendes JJ. Self-reported periodontitis and C-reactive protein in Parkinson’s disease: a cross-sectional study of two American cohorts. npj Parkinson's Disease. 2022 Apr 13;8(1):40.
Daltaban Ö, Enginar AÜ, Üstün K, Hatipoğlu M, Kaçar C, Tuncer T. Evaluating the relationship between ankylosing spondylitis and periodontal disease: a case–control study. Clinical oral investigations. 2023 Jan;27(1):411-20.
Cruz-Ávila J, Hernández-Pérez E, González-González R, Bologna-Molina R, Molina-Frechero N. Periodontal disease in obese patients; Interleukin-6 and C-Reactive protein study: A systematic review. Dentistry Journal. 2022 Nov 29;10(12):225.
Sari A, Dikmen NK, Nibali L. Association between periodontal diseases and COVID-19 infection: a case–control study with a longitudinal arm. Odontology. 2023 Oct;111(4):1009-17.
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Copyright (c) 2025 Dr. Talat Noor, Dr. Talha Asad Khan, Dr. Rabeea Inayat, Dr. Tuba Usman, Dr. Ahmed Saeed Cheema (Author)
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