Effect of Platelet-Rich Fibrin on Alveolar Osteitis and Early Recovery After Mandibular Third Molar Surgery: A Randomized Controlled Trial

Background: Alveolar osteitis is a painful complication after impacted mandibular third molar surgery and is associated with clot disintegration, delayed healing, repeated clinical visits, and increased analgesic use. Platelet-rich fibrin is an autologous fibrin matrix that may enhance clot stability and early tissue repair. Objective: To evaluate the effectiveness of platelet-rich fibrin in reducing alveolar osteitis and improving early recovery after impacted mandibular third molar extraction. Methods: This randomized controlled clinical trial included 60 adults requiring surgical removal of a single impacted mandibular third molar. Participants were allocated to a platelet-rich fibrin group or a conventional socket management group. The primary outcome was alveolar osteitis. Secondary outcomes included pain measured by Visual Analog Scale, facial swelling, Landry Wound Healing Index score, and analgesic consumption during the first post-operative week. Results: Alveolar osteitis occurred in 2 patients in the platelet-rich fibrin group and 8 patients in the control group (6.7% vs 26.7%; p = 0.038). Platelet-rich fibrin was associated with lower pain scores on days 1, 3, and 7, reduced facial swelling on days 3 and 7, better day-7 healing scores, and lower analgesic consumption. Conclusion: Platelet-rich fibrin reduced dry socket incidence and improved early post-operative recovery after mandibular third molar surgery.