Comparison of the effect of injectable platelet rich fibrin and advanced platelet rich fibrin with xenograft on the socket preservation of extracted mandibular molars (a randomized controlled clinical trial)

Various materials and techniques have been employed for socket preservation to minimize alveolar bone resorption in both horizontal and vertical dimensions, as well as to prevent soft tissue collapse following tooth extraction. Due to the regenerative properties of growth factors and proteins released by platelets, the development and application of platelet-enriched preparations have revolutionized the field of regenerative medicine. Thirty healthy participants with non-restorable mandibular teeth were divided into three groups to compare the effects of injectable platelet-rich fibrin (I-PRF) combined with xenograft, advanced platelet-rich fibrin (A-PRF) mixed with xenograft, and xenograft alone on post-extraction socket healing. Blood samples were centrifuged to prepare the PRF materials, which were applied immediately after tooth extraction along with the bone grafts. Clinical healing was assessed one week post-surgery using a modified healing index, while bone density and height were evaluated through standardized radiographs and CBCT scans immediately postoperatively and at intervals up to twelve weeks. Bone density was quantitatively analyzed using ImageJ software by segmenting the socket into specific regions and normalizing the values against background and healthy bone. Bone height measurements were standardized and adjusted to ensure accuracy. Clinical results demonstrated significant improvements in healing across all three groups. At the first week, 50% of patients in Group A and 40% in Group B showed healing, with 100% healing observed in all groups by the fourth week. Bone density measurements revealed significant differences between groups at each follow-up point, with Group B exhibiting the highest mean bone density at the first week, followed by Group A and then Group C. Bone height loss also differed significantly among groups throughout the follow-up period, with Group C experiencing the greatest bone height loss, followed by Group B and then Group A. This study demonstrates that both A-PRF and I-PRF, when combined with xenograft, significantly enhance the healing process and increase bone density in socket preservation following mandibular molar extraction, outperforming the control group treated with xenograft alone. The current study was registered retrospectively at ClinicalTrials.gov (Registration ID: NCT06936358, Date: April 20, 2025).