Comparison of bone repair of advanced platelet-rich fibrin (A-PRF) and leukocyte- and platelet-rich fibrin (L-PRF) following the extraction of impacted third molars: a randomized clinical trial

PURPOSE: To compare the effects of leukocyte- and platelet-rich fibrin (L-PRF) and advanced platelet-rich fibrin (A-PRF) on bone healing and postoperative outcomes following impacted third molar extraction (ITME). METHODS: A randomized, double-blind, split-mouth clinical trial was conducted in patients undergoing bilateral ITME. One extraction socket received L-PRF and the contralateral socket received A-PRF. The primary outcome was bone volume at the extraction socket, assessed by cone-beam computed tomography (CBCT), as a measure of bone healing. Secondary outcomes included trabecular thickness, trabecular spacing, soft tissue healing assessed using the modified Landry healing index, postoperative pain assessed using a visual analog scale (VAS), and facial swelling. Statistical significance was set at p < 0.05. RESULTS: Thirty-five patients were included in the final analysis. No significant differences were observed in bone volume between the L-PRF (21.04 ± 7.46) and A-PRF (21.43 ± 7.65) groups (p = 0.802). Trabecular thickness was significantly greater in the A-PRF group (p = 0.012), whereas trabecular spacing did not differ between groups. An exploratory time-specific comparison showed lower pain scores in the L-PRF group at 8 h postoperatively (p = 0.046), although no significant overall treatment effect was observed for postoperative pain. No significant differences were identified regarding facial swelling or soft tissue healing. CONCLUSION: Within the limitations of this randomized clinical trial, L-PRF and A-PRF demonstrated comparable effects on bone healing and postoperative clinical outcomes following impacted third molar extraction. Trial registration Brazilian registry of clinical trials [ReBEC] number: RBR-10vc6r63.