A split-mouth randomized controlled trial on leukocyte- and platelet-rich fibrin's role in bone density, trabecular complexity, and canine retraction.

BACKGROUND

Orthodontic treatment often leads to alveolar bone loss, necessitating interventions to optimize bone preservation during canine retraction. This study evaluated the efficacy of leukocyte- and platelet-rich fibrin (L-PRF) in enhancing bone density (BD), trabecular architecture, and canine movement following first premolar extraction.

METHODS

A single-center, split-mouth RCT (ClinicalTrials.gov: CTRI/2024/01/061503) enrolled 35 patients (20 males, 15 females; mean age: 18.8 ± 2.04 years males, 19.13 ± 1.96 years females) with Class I bimaxillary protrusion or Class II Division 1 malocclusion, requiring bilateral first premolar extractions (70 sites). Contralateral sockets were randomized (computer-generated sequence, 1:1 ratio) to L-PRF or natural healing (control) to reduce inter-patient variability. Bone density, trabecular patterns, and fractal dimension were evaluated via cone-beam computed tomography scans (ImageJ analysis), and canine movement measured monthly over 4 months using study models. Blinded evaluators analyzed outcomes using t-tests, mixed-model analysis, and Pearson correlations (P < 0.05). Recruitment occurred January 2024-January 2025.

RESULTS

All 70 sites were analyzed (no loss to follow-up). L-PRF significantly increased bone density (562.28 ± 13.63 HU vs. 533.00 ± 5.84 HU, P = 0.001, Cohen's d = 2.79), fractal dimension (1.8 ± 0.12 vs. 1.52 ± 0.15, P = 0.001, Cohen's d = 2.01), and canine movement (3.53 ± 0.23 mm vs. 2.71 ± 0.22 mm, P = 0.001, Cohen's d = 3.48), but with greater tipping. Trabecular complexity improved significantly (P < 0.05). No adverse events occurred.

CONCLUSION

L-PRF significantly enhanced bone density, trabecular architecture, and canine retraction over a follow-up period of four months, offering a promising adjunct to orthodontic treatment.