Platelet-rich fibrin combined with demineralized tooth matrix enhances periodontal regeneration following impacted third molar surgery: a randomized controlled clinical trial.

PURPOSE: To assess the efficacy of the PRF + DTM combination on periodontal tissue status and crestal bone level of the adjacent second molar following third molar surgical removal compared to PRF alone. METHODS: Split-mouth, active-control superiority, randomized controlled trial in participants requiring both lower third molars extracted. DTM + PRF or PRF inserted immediately into each socket after removal. Periodontal statuses were measured preoperatively and 3, 6 and 9 months postoperative. The intra-group and inter-group analysis were done using repeated-measures MANOVA and Paired t-test respectively. RESULTS: Both groups demonstrated significant improvements in all measures at 9 months (p < 0.001*), with superior outcomes in the PRF + DTM group. PD was significantly lower in the PRF + DTM group at all time points: 3 months (3.46 ± 1.22 mm vs. 4.98 ± 1.55 mm; P < 0.001), 6 months (1.67 ± 0.39 mm vs. 3.04 ± 0.99 mm; P < 0.001), and 9 months (1.41 ± 0.32 mm vs. 1.94 ± 0.51 mm; P = 0.002). PD reduction was significantly greater in the PRF + DTM group at all evaluations (7.57 ± 2.12 mm vs. 6.66 ± 1.91 mm; P = 0.045 at 9 months). CAL was significantly lower in the PRF + DTM group at 3 months (2.42 ± 0.50 mm vs. 3.29 ± 1.27 mm; P = 0.009) and 9 months (0.73 ± 0.50 mm vs. 1.14 ± 0.54 mm; P = 0.035), with significantly greater CAL reduction at 3 months (4.94 ± 1.72 mm vs. 3.67 ± 1.71 mm; P = 0.017). Crestal bone gain was significantly greater in the PRF + DTM group at all time points, with the greatest difference at 9 months (6.27 ± 1.30 mm vs. 3.49 ± 1.75 mm; P < 0.001). CONCLUSION: The combination of DTM and PRF could enhance PD, CAL, and CBL improvements compared to PRF alone, indicating superior periodontal and alveolar bone regeneration at the distal aspect of the second molar following third molar surgery. TRIAL REGISTRATION NUMBER (TRN): TCTR20240610006, was registered to Thai Clinical Trial Registry (TCTR) on 10th June 2024.