Does Platelet-Rich Fibrin Enhance Recovery From Neurosensory Disturbance Following Mandibular Fractures? A Double-Blind,Split-Mouth Randomized Clinical Trial

Abstract

Study Design

Randomized Clinical Trial.

Objective

Mandibular body fractures may result in inferior alveolar nerve damage. This study examined the effectiveness of platelet-rich fibrin (PRF) application to the inferior alveolar nerve during open reduction and internal fixation (ORIF) of mandibular fractures.

Methods

This was a double-blind, split-mouth randomized clinical trial. Patients with bilateral mandibular body fractures with minimal displacement (<5 mm) who underwent ORIF were assessed for enrollment. PRF was placed within the fracture site before reduction and fixation on the studied side. Fixation was performed on the contralateral side (control side) without PRF. The study and control groups were randomized using QuickCalcs software. Neurosensory disturbance (NSD) was assessed through two-point discrimination (TPD), self-reported NSD (SR-NSD), and brush directional stroke discrimination test (BDSD) at 6 and 12 months postoperatively.

Results

Twenty-five subjects were enrolled. BDSB recovery was greater in the study group during all time intervals (P < .001). There were no differences between TPD and SR-NSD at the follow-up periods (P > .05).

Conclusions

The results of this split-mouth randomized clinical trial indicate that PRF may enhance the recovery of a damaged inferior alveolar nerve in mandibular body fractures.

Keywords

mandibular fractures mandibular nerve neurosensory platelet-rich fibrin

Get full access to this article

View all access options for this article.

References

Abhinav

Selvarasu

Maheswari

Taltia

. The patterns and etiology of maxillofacial trauma in South India. Ann Maxillofac Surg. 2019;9:114-117.

Alladi

Dhasarathan

ORM

Murugesan

Vivigdha

. Incidence neurosensory deficit in mandibular fractures. Bioinformation. 2023;19:725-728.

Singh

Pal

Singh

. Role of fixation in posttraumatic nerve injury recovery in displaced mandibular angle fracture. Natl J Maxillofac Surg. 2016;7:29-32.

Schenkel

Jacobsen

Rostetter

Grätz

Rücker

Gander

. Inferior alveolar nerve function after open reduction and internal fixation of mandibular fractures. J Cranio-Maxillo-Fac Surg. 2016;44:743-748.

Thurmüller

Dodson

Kaban

. Nerve injuries associated with facial trauma: natural history, management, and outcomes of repair. Oral Maxillofac Surg Clin. 2001;13:283-293.

Tabrizi

Pourdanesh

Khoshnik

Centenero

. Does the lag time between injury and treatment play a role in recovery of inferior alveolar nerve neurosensory disturbances following mandibular body fracture? J Craniofac Surg. 2019;30:2128-2130.

Tay

Lai

Lye

, et al. Inferior alveolar nerve injury in trauma-induced mandible fractures. J Oral Maxillofac Surg. 2015;73:1328-1340.

Boffano

Roccia

Gallesio

Karagozoglu

Forouzanfar

. Inferior alveolar nerve injuries associated with mandibular fractures at risk: a two-center retrospective study. Craniomaxillofacial Trauma Reconstr. 2014;7:280-283.

Canellas

Medeiros

PJD

Figueredo

Fischer

Ritto

. Platelet-rich fibrin in oral surgical procedures: a systematic review and meta-analysis. Int J Oral Maxillofac Surg. 2019;48:395-414.

10.

Bielecki

Dohan Ehrenfest

Everts

Wiczkowski

. The role of leukocytes from L-PRP/L-PRF in wound healing and immune defense: new perspectives. Curr Pharmaceut Biotechnol. 2012;13:1153-1162.

11.

Dohan

Choukroun

Diss

, et al.

Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part III: leucocyte activation: a new feature for platelet concentrates?

Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101:e51-e55.

12.

Zumarán

Parra

Olate

Fernández

Muñoz

Haidar

. The 3 R's for platelet-rich fibrin: a “super” tri-dimensional biomaterial for contemporary naturally-guided oro-maxillo-facial soft and hard tissue repair, reconstruction and regeneration. Materials. 2018;11.

13.

Simonpieri

Del Corso

Vervelle

, et al. Current knowledge and perspectives for the use of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) in oral and maxillofacial surgery part 2: bone graft, implant and reconstructive surgery. Curr Pharmaceut Biotechnol. 2012;13:1231-1256.

14.

Tabrizi

Pourdanesh

Jafari

Behnia

. Can platelet-rich fibrin accelerate neurosensory recovery following sagittal split osteotomy? A double-blind, split-mouth, randomized clinical trial. Int J Oral Maxillofac Surg. 2018;47:1011-1014.

15.

Khojasteh

Hosseinpour

Nazeman

Dehghan

. The effect of a platelet-rich fibrin conduit on neurosensory recovery following inferior alveolar nerve lateralization: a preliminary clinical study. Int J Oral Maxillofac Surg. 2016;45:1303-1308.

16.

Behnia

Ghanbari

Tabrizi

. Does leucocyte-and platelet-rich fibrin enhance neurosensory recovery after genioplasty? A double-blind, split-mouth, randomized clinical trial. Br J Oral Maxillofac Surg 2023;534-539.

17.

Genú

Vasconcelos

. Influence of the tooth section technique in alveolar nerve damage after surgery of impacted lower third molars. Int J Oral Maxillofac Surg. 2008;37:923-928.

18.

Şenses

Önder

Koçyiğit

, et al. Effect of platelet-rich fibrin on peripheral nerve regeneration. J Craniofac Surg. 2016;27:1759-1764.

19.

Smith

Barry

Chiong

, et al. Inferior alveolar nerve damage following removal of mandibular third molar teeth. A prospective study using panoramic radiography. Aust Dent J. 1997;42:149-152.

20.

Antony

Sebastian

Varghese

, et al. Neurosensory evaluation of inferior alveolar nerve after bilateral sagittal split ramus osteotomy of mandible. J Oral Biol Craniofac Res. 2017;7:81-88.

21.

Ghali

Epker

. Clinical neurosensory testing: practical applications. J Oral Maxillofac Surg. 1989;47:1074-1078.

22.

Mohajerani

Tabeie

Bemanali

Tabrizi

. Effect of low-level laser and light-emitting diode on inferior alveolar nerve recovery after sagittal split osteotomy of the mandible: a randomized clinical trial study. J Craniofac Surg. 2017;28:e408-e411.