ADJUNCTIVE EFFECT OF DIODE LASER ON PLATELET-RICH FIBRIN GRAFTING AFTER SURGICAL EXTRACTION OF IMPACTED MANDIBULAR THIRD MOLARS: A SPLIT-MOUTH CLINICAL TRIAL

Background: Pain, facial swelling and trismus are common complications after surgical removal of impacted mandibular third molars. Platelet-rich fibrin (PRF) is widely used to support healing, but the additional benefit of adjunctive diode laser applied on a PRF-grafted socket remains unclear. Objectives: To evaluate the adjunctive effect of diode laser compared with PRF grafting alone on pain, facial swelling and soft tissue healing within the same patient. The trial had two outcomes, namely pain on the visual analogue scale and soft tissue healing on the modified IPR scale, both assessed at day 3 after surgery; secondary outcomes comprised the change in facial swelling, healing scores at days 7 and 30, and postoperative complications. Materials and methods: A split-mouth clinical trial was conducted on 35 patients scheduled for simultaneous bilateral removal of impacted mandibular third molars at the Ho Chi Minh City Hospital of Odonto-Stomatology. Both teeth of each patient were operated in a single session by the same surgeon; both sockets received PRF grafts, and one randomly allocated side received adjunctive 660 nm diode laser irradiation. Pain was assessed on a visual analogue scale at days 1, 3 and 7; facial swelling was measured vertically and horizontally preoperatively and at days 3 and 7; soft tissue healing was scored using a modified IPR scale at days 3, 7 and 30. All between-treatment comparisons were paired. Results: Pain scores were significantly lower on the laser-treated side at day 3 (2.80 ± 0.90 versus 3.37 ± 0.91; p = 0.002) and day 7 (1.17 ± 0.38 versus 1.63 ± 0.49; p = 0.001). Facial swelling peaked at day 3 and decreased by day 7 without returning to baseline on either side; the increase in swelling from baseline to day 3 was significantly smaller on the laser-treated side both vertically (8.46 ± 4.22 mm versus 10.69 ± 4.50 mm; p = 0.043) and horizontally (6.54 ± 2.64 mm versus 8.34 ± 3.26 mm; p = 0.043). Healing scores were higher on the laser-treated side at day 3 (p < 0.001) and day 7 (p = 0.008); by day 30 all 70 sites reached the maximum score. Good healing based on the summed three-timepoint score was achieved in 62.9% versus 20.0% of sides, a paired difference of 42.9% (95% confidence interval: 23.0 – 62.7%; p = 0.001). Conclusions: On a PRF-grafted socket, adjunctive diode laser reduced pain and showed a trend towards a smaller increase in facial swelling in the early postoperative period, and improved soft tissue healing scores at days 3 and 7. These findings apply to a 30-day follow-up period; multicentre studies with larger samples are needed before routine use can be recommended.